Pharmacist Impact in a Post Neuro Intensive Care Virtual Clinic (PREVAIL).

Traditional Post-Intensive Care Recovery Clinics (PIRCs) often exclude neurocritical care patients. In 2020, a multidisciplinary team started Post Neuro Intensive Care Virtual Clinic (PREVAIL) that uses telemedicine to provide consultative care for patients with a primary neurologic injury who are at risk for post-intensive care syndrome. During clinic, critical care pharmacists perform medication reconciliations and provide drug therapy recommendations.

Is the Vertical-Horizontal Illusion a Byproduct of the Environmental Vertical Illusion?

The vertical-horizontal illusion is the overestimation of a vertical line compared to a horizontal line of the same length. Jackson and Cormack (2007) proposed that the vertical-horizontal illusion might be a byproduct of the mechanisms that generate the environmental vertical illusion, which is the tendency to overestimate vertical distances (i.e.

Biomechanical Study of a Subscapularis Repair Technique for Total Shoulder Arthroplasty.

Secure subscapularis repair is an essential element of total shoulder arthroplasty. Some surgeons prefer subscapularis peel because of ease of use, but some evidence suggests that lesser tuberosity osteotomy provides better fixation. The authors developed a novel, through-implant repair technique and performed a biomechanical study of its strength with cadaveric specimens.

Early Outcomes Following Metal-on-Metal Reverse Total Shoulder Arthroplasty in Patients Younger Than 50 Years.

Reverse total shoulder arthroplasty (TSA) is a useful intervention for older patients with glenohumeral arthritis and a deficient rotator cuff. However, as a semiconstrained prosthesis, conventional reverse TSA implanted in a young patient could fail over time secondary to polyethylene wear and subsequent osteolysis. A metal-on-metal prosthesis may avoid this type of failure.

Hyper extension-internal rotation (HERI): A new test for anterior gleno-humeral instability.

Background: Anterior shoulder dislocation causes injury to the inferior gleno-humeral ligament (IGHL) and capsule. Clinical manoeuvres currently used to evaluate the IGHL test for, and may induce, apprehension. We developed the hyper extension-internal rotation (HERI) test to assess the IGHL and inferior capsule without causing apprehension or inducing a risk of gleno-humeral dislocation.

Proximal Biceps Tenodesis: An Anatomic Study and Comparison of the Accuracy of Arthroscopic and Open Techniques Using Interference Screws.

Purpose: To (1) better define the anatomy of the proximal shoulder in relation to the long head of the biceps tendon, (2) compare the length-tension relationship of the biceps tendon in the native shoulder with that after arthroscopic and open tenodesis techniques using interference screws, and (3) provide surgical recommendations for both procedures based on study findings.

Study Design: Descriptive laboratory study.

Methods: Twenty fresh-frozen cadaveric shoulders were dissected for analysis.

Plating of acute humeral diaphyseal fractures through an anterior approach in multiple trauma patients.

Objective: We evaluated the clinical and long-term functional outcomes of humeral diaphyseal fractures treated with acute anterior plating in a trauma population.

Design: Single-center, retrospective cohort analysis with long-term prospective follow-up.

Setting: Urban, Level I trauma center.

Optimization of coded aperture radioscintigraphy for sentinel lymph node mapping.

Purpose: Radioscintigraphic imaging during sentinel lymph node (SLN) mapping could potentially improve localization; however, parallel-hole collimators have certain limitations. In this study, we explored the use of coded aperture (CA) collimators.

Procedures: Equations were derived for the six major dependent variables of CA collimators (i.

Sub-millimeter technetium-99m calibration sources.

Purpose: Small animal radioscintigraphic imaging systems aim to achieve sub-millimeter resolution. At the present time, sub-millimeter calibration sources that can be placed at will within an imaged volume are not readily available. We have developed a method for producing technetium-99m (Tc-99m) sources in less than 15 minutes with readily available reagents.

Coded aperture nuclear scintigraphy: a novel small animal imaging technique.

We introduce and demonstrate the utility of coded aperture (CA) nuclear scintigraphy for imaging small animals. CA imaging uses multiple pinholes in a carefully designed mask pattern, mounted on a conventional gamma camera. System performance was assessed using point sources and phantoms, while several animal experiments were performed to test the usefulness of the imaging system in vivo, with commonly used radiopharmaceuticals.

Regional left ventricular filling: does it reflect diastolic abnormalities in contiguous areas of myocardium?

To test the hypothesis that regional left ventricular filling reflects diastolic changes in contiguous areas of myocardium, we performed radionuclide ventriculograms on normal subjects, patients with left anterior descending coronary artery disease, and patients with anteroseptal myocardial infarctions. We reasoned that because diastolic properties of the anteroseptal myocardium should be different in the three groups of patients, regional filling in the anteroseptal area of the left ventricle should also be different, if regional filling does, indeed, reflect diastolic changes in the adjacent myocardium. While anteroseptal regional filling in the normal subjects was different than regional filling in the two patient groups, the degree of filling abnormality was similar in patients with and without myocardial infarctions.

Regional ejection fraction during exercise: a quantitative measurement to localize coronary artery stenoses in patients with symptomatic or silent myocardial ischemia.

To determine the ability of quantitative radionuclide ventriculography to localize coronary artery stenoses in patients with angina and silent myocardial ischemia, the authors studied changes in regional ejection fractions produced by supine bicycle exercise in 49 patients, 16 of whom had silent myocardial ischemia. For example, in 35 patients with 70 per cent or greater stenoses of the left anterior descending and/or left main coronary artery, anteroseptal regional ejection fraction fell from 55 +/- 3 per cent at rest to 50 +/- 4 per cent with exercise (p less than 0.05).

Equilibrium (gated) radionuclide ejection fraction measurement in the pressure or volume overloaded right ventricle. Comparison of three methods.

Although equilibrium radionuclide angiographic measurement of right ventricular ejection fraction (RVEF) has been validated in patients with coronary artery disease, the accuracy of this technique has not been demonstrated in patients with other cardiac diseases which may result in RV pressure and/or volume overload. The accuracy of three methods of equilibrium radionuclide analysis for measuring RVEF was compared in several subgroups of patients with a variety of cardiac diseases, including congenital and valvular heart disease, cor pulmonale, and cardiomyopathy. It was concluded that RVEF may be accurately derived by equilibrium radionuclide ventriculography in patients with a wide variety of cardiac diseases, including those resulting in RV volume and/or pressure overload.

Effect of the cold pressor test on regional myocardial blood flow in patients with coronary artery disease.

The cold pressor test is a potent alpha-adrenergic vasoconstrictor stimulus, but its effect on regional myocardial blood flow in patients with coronary artery disease is unknown. In this study, 17 patients with chest pain syndromes who were receiving beta-adrenergic-blocking drugs underwent regional myocardial blood flow determination by the xenon-133 technique before and after the cold pressor test. Nineteen of 28 regions analyzed were distal to significant coronary artery lesions (greater than 70% reduction of luminal diameter), while the remainder were in patients with normal coronary arteries.

Beneficial effects of nifedipine on regional myocardial blood flow in patients with coronary artery disease.

Nifedipine inhibits the slow-channel calcium current, which plays a major role in vascular smooth-muscle contraction. However, the effect of nifedipine on regional myocardial blood flow (RMBF) in patients with coronary artery disease (CAD) is unknown. In 18 patients with chest pain syndromes, RMBF was determined with xenon-133 before and after nifedipine.

A simplified technique for measuring right ventricular ejection fraction using the equilibrium radionuclide angiocardiogram and the slant-hole collimator.

The authors developed and tested a simplified technique for measuring the right ventricular ejection fraction (RVEF). Following in vivo 99mTc red cell labeling, equilibrium (ECG-gated) radionuclide angiocardiography was performed in the modified left-anterior-oblique projection using a 30 degree slant-hold collimator. A single region-of-interest was defined from the ejection fraction image, and background was corrected.

Disruption in the temporal sequence of regional ventricular contraction. I. Characteristics and incidence in coronary artery disease.

While spatial asynergy at end-systole has been well characterized in patients with coronary artery disease, assessment of regional asynchrony has been hampered by technical constraints. We developed a computer-assisted method for analyzing regional asynchrony from the equilibrium (ECG-gated) radionuclide ventriculogram. Twenty patients with normal contrast left ventriculograms (nine with a normal coronary arteriogram [group 1] and 11 with coronary artery disease [group 2]) and 20 patients with asynergy during contrast ventriculography (group 3) were studied.

Regional left ventricular function in acute myocardial infarction: evaluation with quantitative radionuclide ventriculography.

Regional and global left ventricular performance was noninvasively assessed with quantitative gated equilibrium radionuclide ventriculography in 43 patients an average of 40 hours after the onset of a first acute transmural myocardial infarction. In all 16 patients with anterior infarction, regional ejection fraction, a quantitative measure of regional left ventricular performance, was uniformly depressed in the infarcted zone. In patients with inferior infarction the abnormalities of regional performance were less severe.

The paradox image: a noninvasive index of regional left-ventricular dyskinesis.

The paradox image, a functional image of regional dyskinesis derived from the equilibrium (gated) radionuclide ventriculogram, was constructed by subtracting the background-corrected end-diastolic frame from the background-corrected end-systolic frame. In 11 patients showing dyskinesis by contract ventriculography, the percentage of left-ventricular picture elements containing paradox ranged from 3.6 to 55.

Regional ejection fraction: a quantative radionuclide index of regional left ventricular performance.

Radionuclide measurements of regional left ventricular ejection fraction were evaluated as a quantitative index of regional left ventricular function. Left ventricular regional ejection fractions were derived from background-corrected, time-activity curves in 43 patients assessed by both gated equilibrium radionuclide angiocardiography and left ventricular contrast angiography. From a single, modified left anterior oblique projection, the regional change in background corrected counts was determined in each of three anatomic regions.

Tantalum-178--a short-lived nuclide for nuclear medicine: production of the parent W-178.

The physical decay characteristics of the short-lived radionuclide Ta-178 (half-life 9.3 min) appear to be suitable for use in conjunction with low-energy detection systems such as the multiwire proportional camera. This camera is inefficient for emissions with energies greater than 100 keV.

Tomographic scintigraphy of regional myocardial perfusion.

Estimation of the extent of regional ischemia by scintigraphic methods has been hampered by the geometric constraints of two-dimensional imaging. Myocardial perfusion scintigraphy was performed using the Fresnel zone-plate tomographic camera after the injection of Tc-99m microspheres (20-40 micron) into a coronary artery. Coronary artery occlusion was performed in six dogs by embolization via a catheter guidewire system.

Quantification of flow in a dynamic phantom using Rb81-Kr81m, and a Nal detector.

Blood flow can be measured by monitoring the count rate of Krypton-81m after its parent, Rubidium-81 (a potassium analogue), has been deposited in the tissue. The steady-state Kr-81m count rate reflects both production by decay of Rb-81 and washout due to blood flow. Its use is theoretically superior to that of Xenon-133 for quantification of blood flow (cc/min per 100 gm) since: (1) multiple flow measurements can be obtained from a single arterial injection, (2) flow-dependent changes in the count rate of Kr-81m provide a steady-state measure of specific flow, and (3) errors due to uptake in fat are eliminated.